Drug Dosing in Acute Kidney Injury

Abstract

It is clear that alterations in renal function will alter medication excretion. However, the type of renal dysfunction may affect other parameters of drug handling. Chronic kidney disease (CKD) influences drug disposition through changes in several pharmacokinetic characteristics. Common pharmacokinetic abnormalities seen in patients with CKD include reduced oral absorption and glomerular filtration, altered tubular secretion and reabsorption, and changes in intestinal and hepatic clearance. Conversely, patients with acute kidney injury (AKI) without preexisting renal dysfunction may handle drugs differently than those patients with CKD or end-stage renal disease. Thus, dosing stratagems extrapolated from patients with CKD may result in subtherapeutic drug concentrations and ineffective treatment. Achieving a balance between under- and overdosing requires rigorous monitoring and individualized dosing. Several published reviews have discussed in great detail drug dosing strategies in CKD and/or patients with AKI receiving renal replacement therapies. This review will focus on key concepts surrounding the dosing of medications in patients with AKI not receiving renal replacement therapies.

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